The influence of sex hormones on anterior cruciate ligament rupture: female study

Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2742-9. doi: 10.1007/s00167-014-3077-3. Epub 2014 May 16.


Purpose: The purpose of this study was to determine the difference in the concentrations of testosterone, 17-β estradiol and progesterone between female patients with and without ACL rupture and the possible effect of these hormones on generalised joint laxity.

Methods: Female subjects with non-contact knee joint injury were included in this study. They were divided into two groups: the examined group, consisting of female subjects with ACL rupture, and the control group, consisting of female patients without ACL rupture. In the next step, the patients from these two groups were paired off on the basis of three factors: the level of professional sports involvement (including the type of sports activity), the side of the body where the injury had occurred (left or right) and the age of the subjects. In the end, there were 12 pairs (24 subjects). The concentrations of sex hormones were established from saliva specimens with the aid of the Salimetrics enzyme immunoassay. Generalised joint laxity was tested with the aid of the "laxity score" according to Beighton, Solomon and Soskolne.

Results: Female subjects with ACL rupture had significantly lower concentrations of testosterone (p < 0.01), significantly lower concentrations of 17-β estradiol (p < 0.05) and significantly lower concentrations of progesterone (p < 0.01) than female subjects with intact ACL.

Conclusions: Decreased concentrations of testosterone, 17-β estradiol or progesterone may be a risk factor leading to ACL rupture. The concentrations of these hormones do not affect generalised joint laxity. Additional research on a larger group of patients is necessary to further determine the effects of these hormones on generalised joint laxity and ACL ruptures. Young female athletes with lower concentrations of sex hormones are more prone to anterior cruciate ligament rupture which is why they need to reduce their sports activities during the pre-ovulatory phase of the menstrual cycle, when these concentrations are additionally reduced.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / physiopathology
  • Anterior Cruciate Ligament Injuries*
  • Athletic Injuries / physiopathology*
  • Estradiol / analysis
  • Female
  • Follicular Phase / physiology
  • Gonadal Steroid Hormones / analysis*
  • Humans
  • Joint Instability / physiopathology*
  • Knee Injuries / physiopathology*
  • Knee Joint / physiopathology
  • Menstrual Cycle / physiology*
  • Progesterone / analysis
  • Risk Factors
  • Rupture
  • Saliva / chemistry
  • Sex Factors
  • Testosterone / analysis
  • Young Adult


  • Gonadal Steroid Hormones
  • Testosterone
  • Progesterone
  • Estradiol